| NPI | 1043224520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: NY 197292) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: FL OS737) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2022-04-14 |